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Grasner JT, Bray JE, Nolan JP, Iwami T, Ong MEH, Finn J, McNally B, Nehme Z, Sasson C, Tijssen J, Lim SL, Tjelmeland I, Wnent J, Dicker B, Nishiyama C, Doherty Z, Welsford M, Perkins GD. Cardiac arrest and cardiopulmonary resuscitation outcome reports: 2024 update of the Utstein Out-of-Hospital Cardiac Arrest Registry template. Resuscitation 2024; 201:110288. [PMID: 39045606 DOI: 10.1016/j.resuscitation.2024.110288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The Utstein Out-of-Hospital Cardiac Arrest Resuscitation Registry Template, introduced in 1991 and updated in 2004 and 2015, standardizes data collection to enable research, evaluation, and comparisons of systems of care. The impetus for the current update stemmed from significant advances in the field and insights from registry development and regional comparisons. This 2024 update involved representatives of the International Liaison Committee on Resuscitation and used a modified Delphi process. Every 2015 Utstein data element was reviewed for relevance, priority (core or supplemental), and improvement. New variables were proposed and refined. All changes were voted on for inclusion. The 2015 domains-system, dispatch, patient, process, and outcomes-were retained. Further clarity is provided for the definitions of out-of-hospital cardiac arrest attended resuscitation and attempted resuscitation. Changes reflect advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes. Time intervals such as emergency medical service response time now emphasize precise reporting of the times used. New flowcharts aid the reporting of system effectiveness for patients with an attempted resuscitation and system efficacy for the Utstein comparator group. Recognizing the varying capacities of emergency systems globally, the writing group provided a minimal dataset for settings with developing emergency medical systems. Supplementary variables are considered useful for research purposes. These revisions aim to elevate data collection and reporting transparency by registries and researchers and to advance international comparisons and collaborations. The overarching objective remains the improvement of outcomes for patients with out-of-hospital cardiac arrest.
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McDonald N, Little N, Kriellaars D, Doupe MB, Giesbrecht G, Pryce RT. Database quality assessment in research in paramedicine: a scoping review. Scand J Trauma Resusc Emerg Med 2023; 31:78. [PMID: 37951904 PMCID: PMC10638787 DOI: 10.1186/s13049-023-01145-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/05/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Research in paramedicine faces challenges in developing research capacity, including access to high-quality data. A variety of unique factors in the paramedic work environment influence data quality. In other fields of healthcare, data quality assessment (DQA) frameworks provide common methods of quality assessment as well as standards of transparent reporting. No similar DQA frameworks exist for paramedicine, and practices related to DQA are sporadically reported. This scoping review aims to describe the range, extent, and nature of DQA practices within research in paramedicine. METHODS This review followed a registered and published protocol. In consultation with a professional librarian, a search strategy was developed and applied to MEDLINE (National Library of Medicine), EMBASE (Elsevier), Scopus (Elsevier), and CINAHL (EBSCO) to identify studies published from 2011 through 2021 that assess paramedic data quality as a stated goal. Studies that reported quantitative results of DQA using data that relate primarily to the paramedic practice environment were included. Protocols, commentaries, and similar study types were excluded. Title/abstract screening was conducted by two reviewers; full-text screening was conducted by two, with a third participating to resolve disagreements. Data were extracted using a piloted data-charting form. RESULTS Searching yielded 10,105 unique articles. After title and abstract screening, 199 remained for full-text review; 97 were included in the analysis. Included studies varied widely in many characteristics. Majorities were conducted in the United States (51%), assessed data containing between 100 and 9,999 records (61%), or assessed one of three topic areas: data, trauma, or out-of-hospital cardiac arrest (61%). All data-quality domains assessed could be grouped under 5 summary domains: completeness, linkage, accuracy, reliability, and representativeness. CONCLUSIONS There are few common standards in terms of variables, domains, methods, or quality thresholds for DQA in paramedic research. Terminology used to describe quality domains varied among included studies and frequently overlapped. The included studies showed no evidence of assessing some domains and emerging topics seen in other areas of healthcare. Research in paramedicine would benefit from a standardized framework for DQA that allows for local variation while establishing common methods, terminology, and reporting standards.
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Affiliation(s)
- Neil McDonald
- Winnipeg Fire Paramedic Service, EMS Training, 2546 McPhillips St, Winnipeg, MB, R2P 2T2, Canada.
- Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, S203 Medical Services Building, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada.
- Applied Health Sciences, University of Manitoba, 202 Active Living Centre, Winnipeg, MB, R3T 2N2, Canada.
| | - Nicola Little
- Winnipeg Fire Paramedic Service, EMS Training, 2546 McPhillips St, Winnipeg, MB, R2P 2T2, Canada
| | - Dean Kriellaars
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada
| | - Gordon Giesbrecht
- Faculty of Kinesiology and Recreation Management, University of Manitoba, 102-420 University Crescent, Winnipeg, MB, R3T 2N2, Canada
| | - Rob T Pryce
- Department of Kinesiology and Applied Health, Gupta Faculty of Kinesiology, University of Winnipeg, 400 Spence St, Winnipeg, MB, R3B 2E9, Canada
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Somma V, Pflaumer A, Connell V, Rowe S, Fahy L, Zentner D, James P, Ingles J, Semsarian C, Stub D, Nehme Z, La Gerche A, Paratz ED. Epidemiology of pediatric out-of-hospital cardiac arrest compared with adults. Heart Rhythm 2023; 20:1525-1531. [PMID: 37331677 DOI: 10.1016/j.hrthm.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is associated with ∼90% mortality rate. In the pediatric population, this would equate to a large number of years of life lost, posing a heavy medical and economic burden to society. OBJECTIVE The purpose of this study was to outline the characteristics and causes of pediatric OHCA (pOHCA) and associations with survival until discharge in patients enrolled in the End Unexplained Cardiac Death Registry. METHODS A prospective statewide multisource registry identified all pOHCAs cases in patients aged 1-18 years in Victoria, Australia (population 6.5 million), from April 2019 to April 2021. Cases were adjudicated using ambulance, hospital, and forensic records; clinic assessments; and interviews of survivors and family members. RESULTS The analysis included 106 cases after adjudication (62, 58.5% male), 45 (42.5%) of which were due to cardiac causes of OHCA, with unascertained (n = 33 [31.1%]) being the most common cardiac cause reported. Respiratory events (n = 28 [26.4%]) were the most common noncardiac cause of pOHCA. Noncardiac causes were more likely to present with asystole or pulseless electrical activity (P = .007). The overall survival to hospital discharge rate was 11.3% and associated with increasing age, witnessed cardiac arrest, and initial ventricular arrhythmias (P < .05). CONCLUSION The incidence of pOHCA in the study population was 3.69 per 100,000 child-years. In contrast to young adults with OHCA, the most common etiology was noncardiac in pediatric patients. Prognostic factors associated with survival to discharge included increasing age, witnessed arrest, and initial ventricular arrhythmias. Rates of cardiopulmonary resuscitation and defibrillation were suboptimal.
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Affiliation(s)
- Vincenzo Somma
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia
| | | | - Stephanie Rowe
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Louise Fahy
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Dominica Zentner
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Melbourne Hospital, St Parkville, Victoria, Australia
| | - Paul James
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Melbourne Hospital, St Parkville, Victoria, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, St Darlinghurst, New South Wales, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dion Stub
- Alfred Hospital, Prahran, Victoria, Australia
| | - Ziad Nehme
- Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Andre La Gerche
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Elizabeth D Paratz
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia.
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Trends in the incidence and outcome of paediatric out-of-hospital cardiac arrest: A 17-year observational study. Resuscitation 2018; 128:43-50. [DOI: 10.1016/j.resuscitation.2018.04.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022]
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Masterson S, Strömsöe A, Cullinan J, Deasy C, Vellinga A. Apples to apples: can differences in out-of-hospital cardiac arrest incidence and outcomes between Sweden and Ireland be explained by core Utstein variables? Scand J Trauma Resusc Emerg Med 2018; 26:37. [PMID: 29724238 PMCID: PMC5934807 DOI: 10.1186/s13049-018-0505-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/25/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Variation in reported incidence and outcome based on aggregated data is a persistent feature of out-of-hospital cardiac arrest (OHCA) epidemiology. OBJECTIVE To investigate the extent to which patient-level analysis using core 'Utstein' variables explains inter-country variation between Sweden and the Republic of Ireland. METHODS A retrospective cross-sectional comparative study was performed, including all Swedish and Irish OHCA cases attended by Emergency Medical Services (EMS-attended OHCA) where resuscitation was attempted from 1st January 2012 to 31st December 2014. Incidence rates per 100,000 population were adjusted for age and gender. Two subgroups were extracted: (1) Utstein - adult patients, bystander-witnessed collapse, presumed medical aetiology, initial shockable rhythm and (2) Emergency Medical Service (EMS)-witnessed events. Multivariable logistic regression analysis was used to identify predictors of survival following multiple imputations of data. RESULTS Five thousand eight hundred eighty six Irish and 15,303 Swedish patients were included. Swedish patients were older than Irish patients (median age 71 vs. 66 years respectively). Adjusted incidence was significantly higher in Sweden compared to the Republic of Ireland (52.9 vs. 43.1 per 100,000 population per year). Proportionate survival in Sweden was greater for both subgroups and all age categories. Regression analysis of the Utstein subgroup predicted approximately 17% of variation in outcome, but there was a large unexplained 'country effect' for survival in favour of Sweden (OR 4.40 (95% CI 2.55-7.56)). CONCLUSIONS Using patient level data, a proportion of inter-country variation was explained, but substantial variation was not explained by the core Utstein variables. Researchers and policy makers should be aware of the potential for unmeasured differences when comparing OHCA incidence and outcomes between countries.
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Affiliation(s)
- Siobhán Masterson
- Discipline of General Practice, National University of Ireland Galway, Distillery Road, Newcastle, Galway, Ireland.
| | | | - John Cullinan
- School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Conor Deasy
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Akke Vellinga
- School of Medicine, National University of Ireland Galway, Galway, Ireland
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Ho YK, Mok YT. Epidemiology of Paediatric Out-of-Hospital Cardiac Arrest Presented to a Local Emergency Department: A Retrospective Case Series. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To outline the epidemiology of paediatric out-of-hospital cardiac arrest (OHCA) cases presented to a regional hospital. Design Retrospective case series. Methods Attendance records of critical cases aged from 0 to 17 years old from year 2001 to 2014 attending Emergency Department (ED) of Yan Chai Hospital were searched. Demographic data and predictive parameters were analysed for association with outcome. Results There were 40 cases of paediatric OHCA throughout the study period. A total of 21 (52.5%) had witnessed arrest; 27 (67.5%) had cardiac arrest at home. Twenty-eight (70%) of the cardiac arrest were first noted by family members; 8 (20%) received bystander cardiopulmonary resuscitation (CPR). Only 13 (32.5%) cases had return of spontaneous circulation (ROSC) in the ED and were admitted. Seven patients (17.5%) survived to hospital discharge. Conclusion Paediatric OHCA, although a rare occurrence, has a high mortality of 82.5% in our series. Majority of the cases occur at home, and are witnessed. Family members are often the first persons to detect the arrest. Yet the rate of providing bystander CPR is low in Hong Kong.
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Improving Measurement of Outcomes in Cardiac Arrest Trials. Pediatr Crit Care Med 2016; 17:1190-1191. [PMID: 27918393 DOI: 10.1097/pcc.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pediatric Out-of-Hospital Cardiac Arrest Characteristics and Their Association With Survival and Neurobehavioral Outcome. Pediatr Crit Care Med 2016; 17:e543-e550. [PMID: 27679965 PMCID: PMC5138073 DOI: 10.1097/pcc.0000000000000969] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate relationships between cardiac arrest characteristics and survival and neurobehavioral outcome among children recruited to the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial. DESIGN Secondary analysis of Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial data. SETTING Thirty-six PICUs in the United States and Canada. PATIENTS All children (n = 295) had chest compressions for greater than or equal to 2 minutes, were comatose, and required mechanical ventilation after return of circulation. INTERVENTIONS Neurobehavioral function was assessed using the Vineland Adaptive Behavior Scales, Second Edition at baseline (reflecting prearrest status) and 12 months postarrest. U.S. norms for Vineland Adaptive Behavior Scales, Second Edition scores are 100 (mean) ± 15 (SD). Higher scores indicate better functioning. Outcomes included 12-month survival and 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70. MEASUREMENT AND MAIN RESULTS Cardiac etiology of arrest, initial arrest rhythm of ventricular fibrillation/tachycardia, shorter duration of chest compressions, compressions not required at hospital arrival, fewer epinephrine doses, and witnessed arrest were associated with greater 12-month survival and 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70. Weekend arrest was associated with lower 12-month survival. Body habitus was associated with 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70; underweight children had better outcomes, and obese children had worse outcomes. On multivariate analysis, acute life threatening event/sudden unexpected infant death, chest compressions more than 30 minutes, and weekend arrest were associated with lower 12-month survival; witnessed arrest was associated with greater 12-month survival. Acute life threatening event/sudden unexpected infant death, other respiratory causes of arrest except drowning, other/unknown causes of arrest, and compressions more than 30 minutes were associated with lower 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70. CONCLUSIONS Many factors are associated with survival and neurobehavioral outcome among children who are comatose and require mechanical ventilation after out-of-hospital cardiac arrest. These factors may be useful for identifying children at risk for poor outcomes, and for improving prevention and resuscitation strategies.
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Inoue M, Tohira H, Williams T, Bailey P, Borland M, McKenzie N, Brink D, Finn J. Incidence, characteristics and survival outcomes of out-of-hospital cardiac arrest in children and adolescents between 1997 and 2014 in Perth, Western Australia. Emerg Med Australas 2016; 29:69-76. [DOI: 10.1111/1742-6723.12657] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/24/2016] [Accepted: 07/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Madoka Inoue
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine; Curtin University; Perth Western Australia Australia
| | - Hideo Tohira
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine; Curtin University; Perth Western Australia Australia
| | - Teresa Williams
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine; Curtin University; Perth Western Australia Australia
- St John Ambulance Western Australia (SJA-WA); Perth Western Australia Australia
| | - Paul Bailey
- St John Ambulance Western Australia (SJA-WA); Perth Western Australia Australia
- Emergency Department; St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Meredith Borland
- Schools of Paediatric and Child Health, and Primary, Aboriginal and Rural Health Care; The University of Western Australia; Perth Western Australia Australia
- Emergency Department; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - Nicole McKenzie
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine; Curtin University; Perth Western Australia Australia
| | - Deon Brink
- St John Ambulance Western Australia (SJA-WA); Perth Western Australia Australia
| | - Judith Finn
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine; Curtin University; Perth Western Australia Australia
- St John Ambulance Western Australia (SJA-WA); Perth Western Australia Australia
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
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Improving Survival and Neurologic Function for Younger Age Groups After Out-of-Hospital Cardiac Arrest in Sweden: A 20-Year Comparison. Pediatr Crit Care Med 2015. [PMID: 26218255 DOI: 10.1097/pcc.0000000000000503] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe changes in the epidemiology of out-of-hospital cardiac arrest in Sweden with the emphasis on the younger age groups. DESIGN Prospective observational study. SETTING Sweden. PATIENTS Patients were recruited from the Swedish Registry of Cardiopulmonary Resuscitation from 1990 to 2012. Only non-crew-witnessed cases were included. INTERVENTION Cardiopulmonary resuscitation. MEASUREMENT AND MAIN RESULTS The endpoint was 30-day survival. Cerebral function among survivors was estimated according to the cerebral performance category scores. In all, 50,879 patients in the survey had an out-of-hospital cardiac arrest, of which 1,321 (2.6%) were 21 years old or younger and 1,543 (3.0%) were 22-35 years old. On the basis of results from 2011 and 2012, we estimated that there are 4.9 cases per 100,000 person-years in the age group 0-21 years. The highest survival was found in the 13- to 21-year age group (12.6%). Among patients 21 years old or younger, the following were associated with an increased chance of survival: increasing age, male gender, witnessed out-of-hospital cardiac arrest, ventricular fibrillation, and a short emergency medical service response time. Among patients 21 years old or younger , there was an increase in survival from 6.2% in 1992-1998 to 14.0% in 2007-2012. Among 30-day survivors, 91% had a cerebral performance category score of 1 or 2 (good cerebral performance or moderate cerebral disability) at hospital discharge. CONCLUSIONS In Sweden, among patients 21 years old or younger, five out-of-hospital cardiac arrests per 100,000 person-years occur and survival in this patient group has more than doubled during the past two decades. The majority of survivors have good or relatively good cerebral function.
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Trends in the incidence of presumed cardiac out-of-hospital cardiac arrest in Perth, Western Australia, 1997–2010. Resuscitation 2014; 85:757-61. [DOI: 10.1016/j.resuscitation.2014.02.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/24/2014] [Accepted: 02/21/2014] [Indexed: 11/21/2022]
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